“ Monsters don’t sleep under your bed. They sleep inside your head. ”

© Pieter Harris.

The what if? problem – general anxiety disorder

1. Introduction

Most people who are diagnosed with generalized anxiety disorder, are usually surprised by their diagnosis. Most people suffering from this disorder ordinarily appear (and feel) quiet and calm. Yet, more than fifty percent of my practice consists of people suffering from this.

2. You accepted and expected that this is just the way life is

Growing up, I had a dog called Bobbel. Bobbel and I had a very strange relationship. We were inseparable, but had fights, regularly. Sometimes my father would just look at us and mumble: “Poor Bobbel, he just assumes that this is what life is all about”.

3. General anxiety disorder

General anxiety disorder is characterized by chronic stress, present for a period of at least six months, without experiencing panic attacks, phobias and/or obsessions. You simply experience ongoing stress and worries.

In order to be diagnosed with general anxiety disorder, your anxiety and worries have to be focused on at least two stressful life experiences e.g. finances, relationships, health, work/school performance etc. for more days than not, in a period exceeding six months. It is also very common that a person dealing with general anxiety disorder spends a lot of time worrying. They struggle to control their worries. The intensity and frequency of these worries are always out of proportion in comparison to the possibility of it actually happening.

Diagnostic criteria of a general anxiety disorder according to the DSM 5:

Excessive anxiety and worry (always expecting the worst), occurring more often than not, for a period of at least six months, relating to a number of events or activities. The person finds it difficult to control the worry. The anxiety and worry are associated with three or more of the following symptoms:

• Restlessness or feeling keyed up or “on edge”
• Being easily fatigued
• Difficulty concentrating or your mind going blank
• Irritability
• Muscle tension
• Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep).

You might find it difficult to relax. You constantly feel restless. You cannot watch an entire movie on television, without constantly jumping up and doing something else. By midday you might feel entirely exhausted and sleepy. You could, for example start reading a magazine, only to realize after a paragraph or two, that you have absolutely no idea what it is that you are reading. Many older people even start believing that they are developing a form of dementia, such as Alzheimer’s disease. It is probably only anxiety. You are easily irritated and loud noises, especially, may frustrate you endlessly. You may experience muscle tension, particularly in your shoulders and neck. You might blame it on continuously sitting behind a desk, however this is not the case. Finally, you might even be called an insomniac. In short, you will be labelled a control freak. You are probably simply just suffering from generalized anxiety disorder.

The anxiety, worry, or physical symptoms cause clinically significant distress of impairment in social, occupational, or other important areas of functioning.

4. Co-existing conditions

People suffering from general anxiety disorder also often experience anxiety/panic attacks. (Read more about this on my website: Other conditions such as obsessive compulsive disorder (OCD), phobias, social anxiety, stage fright and post traumatic stress disorder (PTSD) might co-exist with general anxiety disorder.

General anxiety is often the cause of most addictions such as alcohol abuse.

5. The physiology behind generalized anxiety disorder

In general terms, general anxiety disorder is referred to as stress. Strictly, psychologically speaking, however, the term stress does not exist. It simply is general anxiety disorder.

It is usually not your circumstances that cause stress or anxiety, but rather the way you think about it. These thoughts usually start with “What if …?” “What if this happens” or “what if I do or don’t?”.

In nature, an animal will naturally secrete adrenaline and nor-adrenaline, when it finds itself in a compromising/dangerous situation, to enable it to fight or flee (the so-called fight or flight response). Its’  heart rate accelerates, muscles contract, breathing becomes faster and thoracic etc. enabling it to fight harder or escape faster. Once out of danger, the animal goes to sleep so that its’ body can rebuild its’ adrenaline levels. Humans however, cannot utilize adrenaline the way an animal does. We cannot assault our bank manager or run away from the tax-man, consequently trapping the adrenaline within our bodies, resulting in anxiety.

There is yet another factor that distinguishes humans from animals. Irrational thoughts can sometimes cause us so view something as a threat, even if it is not. The same part of the brain is activated when you assume you are being threatened as when you actually are. Your body receives a message warning it against eminent danger and as a result it starts producing adrenaline, enabling the fight or flight response.

These thoughts are usually accompanied by the what if? questions. I refer to anxiety as the “what if?” disease. We torture ourselves with questions about possible catastrophes. Most of these fears hardly ever materialize.

6. Life doesn’t have to be this way

Someone once said: Relax, you are not in control anyway!

Why should we worry ourselves… as mentioned, we are not in control anyway. We have been conditioned to believe that the world is a dangerous place and we should be cautious at all times. We complicate our lives and only we are responsible for it. Even in the Scriptures there are numerous references to the fact that we need not concern ourselves. Nothing is ever accomplished by that, anyway.